2026 Grad Blessing Bag Submission Form
Hosted by Kindness in Motion a program of the Kimberly Brown Network (501c3)
Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Birth Date
-
Month
-
Day
Year
Birth Date
Name a parent we can contact on your behalf
First Name
Last Name
Email of that same parent we can contact on your behalf
example@example.com
Phone Number of that same parent we can contact on your behalf
-
Area Code
Phone Number
What is your gender?
Name the high school from which you are graduating
List city that your high school is located in
Did you graduate with honors?
Yes
No
What are your plans after graduation?
Higher Education/College
Career/Work
Military
Other Training
If you are continuing your education, where will you be attending this fall?
If military, which branch?
If other training please share
How did you hear about Grad Blessing Bags?
List Church Affiliation (If any)
Do you use an iPhone or Android?
Do you wear contact lenses?
Yes
No
Who in your life gave you the greatest strength and most support to graduate?
If you could end one world problem, what would it be?
What is your favorite color?
What is your favorite restaurant?
What are your hobbies?
Please list any volunteer work/community engagement:
Do you have any health concerns, allergies or meal limitations?
I understand that attendance to the Grad Blessing Bag Celebration on June 13, 2026 at 3pm is mandatory. Also, that 2 additional guest seats will be reserved for my parents.
Yes
Is there anything else you would like us to know about you in consideration of your submission?
Fun facts, challenges you have overcome, anything...
Signature
Submit
Should be Empty: